Stamp Out Childhood Obesity Jodi Jakey, Renee Ivers, Sara Towers, Sheri VanDeBurg, Zach Holmes
Vulnerable Population • US Citizens. Michigan residents • Men of higher income, women of lower income (but not impoverished) (Ogden, Lamb, Carroll,& Flegal, 2010) • Women, not college educated (Ogden, Lamb, Carroll,& Flegal, 2010) • Black, Mexican, Hispanic,& Native American decent (CDC, 2013) • Obese parents are more likely to have obese children, which are more likely to become obese adults (American Academy of Child & Adolescent Psychiatry, 2011) (CDC, 2013)
Trends in Children • Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years. • The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period. • In 2010, more than one third of children and adolescents were overweight or obese. (CDC,2013)
Income and Behavior • Childhood obesity rises as income lowers (Eagle, et al, 2012) • Decreased community resources results in decreased physical activity and increased screen time (T.V., internet, etc.)
Cultural Influences Highest increases in childhood obesity occurred in Hispanic and Mexican-American boys & girls • Cultural eating practices • Cultural distrust of the medical profession • Fatalism • Persons of certain cultures fail to recognize their children are overweight (Fitzgibbon & Beech, 2009)
Health-risk factors in Obese Adolescents • Increase cardiovascular disease • Increase blood pressure • Pre-diabetes and Type 2 diabetes • Bone and joint problems • Sleep apnea • Increase risk for some types of cancer • Sugary drinks lead to tooth decay • Gout • Social and emotional trouble • Peer stigmatization • Discrimination • Bullying www.Michigan.gov, http://www.healthykidshealthymich.com, Ludwig, D.S, Peterson K.E., Gortmaker, S.L. (February 2001). Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet. (9255:505-8)
Statistics related to population and health risk factors • 18.2% of Michigan youth ages 10-17 years old are overweight and 12.4% are considered obese compared to the U.S. percentage of 15.3 overweight and 16.4 obese. (National Survey of Children’s Health,2007) • Between 1979 & 1999, obesity associated hospital costs for children tripled from 35 million to 127 million. (www.healthykidshealthymich.com)
80% of youth did not consume adequate (5 or more) servings of fruits and vegetables per day • 28% of youth drank at least one pop or soda a day. • Males (32%) drank soda more often than females (23%) • Youth participation in physical education classes on a daily basis was very limited (31%) • Only 47% of youth were physically active for at least 60 minutes per day on five or more of the past seven days. • On an average school day, approximately 30% of youth spent 3 or more hours watching television, while 23% of youth uses computer or video games 3 or more hours. • Black youth had the highest prevalence of excessive television viewing (48%) and computer or video game use (28%) (www.michigan.gov/.../Overweight_and_Obesity_in_Michigan_Surveilla.)
Statistics related to population and health risk factors continued • In 2009, male youth (15.7%) had a significantly higher obesity rate than females (8.0%) • Only 34% of youth in Kent County report eating healthy balanced meals. • 45% of youth report being physically inactive (less than 60 minutes of exercise during the last 7 days.) • Television is an obesity machine= Kids watch an average of 20 hours of TV per week, over 1000 hours per year- TV is believed to be one of the most sedentary activities that exists. Kids average approximately 6 hours of screen time per day. (www.kentcountyhealthconnect.org/TheFacts.aspx)
Environmental Risk factors • Increase consumption of foods away from home • Larger portion sizes • Increase TV viewing • Decrease walking and biking to/from school • Increase consumption of soft drinks or sugar-sweet drinks • Lack of physical education in schools Thoms, S Childhood Obesity: Fitkids 360 aims to reverse the tide in Kent County. Retrieved from www.mlive.com/living/grand-rapids/index.ssf/2012/12/childhood_obesity_fitkids_360.html
Community Risk Factors • Lack of healthy food resources • Dependence on corner stores that do not always carry healthy food options or do at cost prohibitive prices • Food and drink choices made based on convenience, affordability, prevalence of fast food chains. Kent County Health Needs Assessment. (2011). Michigan Public Health Institute. Retrieved November 16, 2013 from www.spectrumhealth.org/documents/kent_county_CHNA _report_no_cover.pdf, Supplemental Nutrition Assistance Program Eligible Food Items. Retrieved November 18, 2013 from http://www.fns.usda.gov/snap/eligible-food-items
Why do kids consume sugary drinks? • $3.2 billion spent in advertising carbonated beverages in 2006 • Lack of education regarding risks • Drink juice instead of eating fruit • Caffeine buzz • Convenience
Nola Penders Health Promotion Model (Pender, Murdaugh, Parsons, 2011) • Characteristics= each person is unique with defining characteristics, behaviors and experiences that impact their actions. These characteristics and experiences include prior behaviors. • Prior behavior and habit formation impact the likelihood and success maintaining health promoting behaviors. • Health promotion model highlights that- “If short term benefits are experienced early in the course of the behavior, the behavior is more likely to be repeated.” (p. 46) “An individual’s expectations to engage in a particular behavior hinge on the anticipated benefits.”(p. 46)
Nola Penders Health Promotion Model (Pender, Murdaugh, Parsons, 2011) • Perceived Barriers- “Barriers consist of perceptions about the unavailability, inconvenience, expense, difficulty or time-consuming nature of a particular action.” (p. 47) “Loss of satisfaction from giving up health damaging behaviors such as smoking or eating high fat foods to adopt healthier lifestyles may also constitute a barrier.” (p. 47)
Nola Penders Health Promotion Model • Perceived self-efficacy= the belief that one has the personal capability of carrying out a particular action. • Activity-Related effect=the feeling that impacts the person-is it negative or positive- and how this feeling impacts the persons likelihood to continue the healthier behavior. • Interpersonal - Influences= the influence of family, peers, and people on the health promoting behavior. • Situational Influences “Situational influences on health promoting behaviors include perceptions of options available, demanding characteristics, and aesthetic features of the environment in which a given behavior is proposed to take place.” (p. 48-49) • Commitment to a Plan of Action- Initiates a behavioral event. “Commitment alone without associated strategies often results in ‘good intentions’ but failure to perform the health behavior.” (p.49)
Effects of Soft Drink Consumption on Nutrition and Health • Soft drink consumption is believed to be a major contributor to obesity and health related problems (para3) • Soft drinks are banned from schools in Britain, France, and portions of the United States. (para3) • People who consume soft drinks do not decrease intake in other areas of eating, thus increase overall caloric consumption. (Para 22) • The increased carbohydrate intake associated with soft drink consumption primarily reflects greater consumption of added sugar. (Para 31) • The fact that soft drinks offer energy with little accompanying nutrition, displace other nutritional resources, and are linked to several key health conditions such as diabetes is further impetus to recommend a reduction in soft drink consumption. (Para 50) Vartanian, L. R., Scwartz, M. B., & Brownell, K. D. (2007, April). Effects of soft drink consumption on nutrition and health: A systematic review and meta-analysis. American Journal of Public Health, 97(4), 75-667. doi:10.2105/ajph.2005.083782
Plan of Action to address health issue Strategies for Reducing Sugar-Sweetened Beverage Consumption • Modifiable behavior • Easily accessible • Diabetes Prevention Program • Limit access to sugar-sweetened beverages
Potential Action Steps • Price adjustments • Greater proportion • Assemble a meeting • Collaborate with state and school district officials • Redefine or eliminate beverage “pouring contracts” in schools.
Promote access to and consumption of more healthy alternatives to sugar-sweetened beverages • Meeting daily nutrient needs • Reducing sugar-sweetened beverages consumption • Beverage consumption patterns of parents • Provide education • Support
Evaluation of the plan of action • No single solution to this problem exists • The highest consumers of sugar-sweetened beverages are adolescents aged 12 to 19 years • Bottled water sales have increased • 2004-2008 changes
School Beverage Guidelines • Elementary Schools • Bottled water • Up to 8 ounce servings of milk and 100% juice • Fat-free or low-fat regular and flavored milk and nutritionally equivalent (per USDA) milk alternatives with up to 150 calories/ 8 ounces • 100% juice with no added sweeteners, up to 120 calories / 8 ounces, and with at least 10% of the recommended daily value for three or more vitamins and minerals • Middle School • Same as elementary school, except juice and milk may be sold in 10 ounce servings • As a practical matter, if middle school and high school students have shared access to areas on a common campus or in common buildings, then the school community has the option to adopt the high school standard • High School • Bottled water • No- or low-calorie beverages with up to 10 calories / 8 ounces • Up to 12 ounce servings of milk, 100% juice and certain other drinks • Fat-free or low-fat regular and flavored milk and nutritionally equivalent (per USDA) milk alternatives with up to 150 calories / 8 ounces* • 100% juice with no added sweeteners, up to 120 calories / 8 ounces, and with at least 10% of the recommended daily value for three or more vitamins and minerals • Other drinks with no more than 66 calories / 8 ounces • At least 50% of non-milk beverages must be water and no- or low-calorie options
Nutrition and Weight Status Goal Promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights. Overview The Nutrition and Weight Status objectives for Healthy People 2020 reflect strong science supporting the health benefits of eating a healthful diet and maintaining a healthy body weight. The objectives also emphasize that efforts to change diet and weight should address individual behaviors, as well as the policies and environments that support these behaviors in settings such as schools, worksites, health care organizations, and communities. The goal of promoting healthful diets and healthy weight encompasses increasing household food security and eliminating hunger.
Americans with a healthful diet: Consume a variety of nutrient-dense foods within and across the food groups, especially whole grains, fruits, vegetables, low-fat or fat-free milk or milk products, and lean meats and other protein sources. Limit the intake of saturated and trans fats, cholesterol, added sugars, sodium (salt), and alcohol. Limit caloric intake to meet caloric needs.
Understanding Nutrition and Weight Status Diet Diet reflects the variety of foods and beverages consumed over time and in settings such as worksites, schools, restaurants, and the home. Interventions to support a healthier diet can help ensure that: • Individuals have the knowledge and skills to make healthier choices. • Healthier options are available and affordable.
Increase the proportion of schools that offer nutritious foods and beverages outside of school meals
Reduce consumption of calories from solid fats and added sugars in the population aged 2 years and older
References • American Academy of Child & Adolescent Psychiatry. 2011. Obesity in children & teens. Retrieved from http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Obesity_In_Children_And_Teens_79.aspx • Briefel, R., Wilson, A., Cabili, C., Dodd, A. (2013). Reducing calories and added sugars by improving children’s beverage choices. Journal of the academy of nutrition and dietetics. 113(2). 269-275. • Centers for Disease Control and Prevention. 2013. Adolescent and school health. Childhood obesity facts. Retrieved from http://www.cdc.gov/healthyyouth/obesity/facts.htm • County of Los Angeles Public Health (n.d.) Sugar loaded drinks. http://www.choosehealthla.com/eat-healthy/sugar-loaded-beverages/
More References • Eagle T.F., Sheetz, A., Gurm, R., Woodward, A.C., Kline-Rogers, E., Leibowitz, R., Durussel-Weston, J., Palma-Davis, L., Aaronson, S., Fitzgerald, C.M., Mitchell, L.R., Rogers, B., Bruenger, P., Skala, K.A., Goldberg, C., Jackson, E.A., Erickson, S.R., Eagle, K.A. 2012.Understanding childhood obesity in America: linkages between household income, community resources, and children's behaviors. Am Heart J.,163(5):836-43. doi: 10.1016/j.ahj.2012.02.025 http://www.ncbi.nlm.nih.gov/pubmed/22607862 • Harvard School of Public Health Department of Nutrition. (June 2012) Fact Sheet: sugary drink supersizing and the obesity epidemic. Retrieved November 16, 2013 from http://www.hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet/ • Health Canada (2007). Sugar shocker. http://www.capitalhealth.ca/NR/rdonlyres/e6nstouxulgpkbvzot7as7dhtyvv6storxwnl57sbz4gl6o2im2rgwio4tthag2r5vag2aoqodp7fst6zyagrafdccb/Sugar+shocker.pdf
More References • Healthy Kids, Healthy Michigan. (2008). In Healthy Kids, Healthy Michigan: Advocates for Healthy Weight in Children. Retrieved November 14, 2013, from http://www.healthykidshealthymich.com • Healthypeople.gov (2013). Nutrition and weight status. http://www.healthypeople.gov/2020/default.aspx • Kent County Health Needs Assessment. (2011). Michigan Public Health Institute. Retrieved November 16, 2013 from www.spectrumhealth.org/documents/kent_county_CHNA _report_no_cover.pdf • In Kent county. (2013). In Kent County Health Connect: A Bridge to Healthy Living. Retrieved November 14, 2013, from http://www.kentcountyhealthconnect.org/TheFacts.aspx
More References • Ludwig, D.S, Peterson K.E., Gortmaker, S.L. (February 2001). Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet. (9255:505-8) • Michigan Department of Community Health. (2011) Overweight and Obesity in Michigan: Surveillance Update 2011. Retrieved November 14, 2013, from www.michigan.gov/.../Overweight_and_Obesity_in_Michigan_Surveilla.. • Ogden, C. L., Lamb, M. M., Carroll, M. D., & Flegal, K. M.. 2010. Obesity and Socioeconomic Status in Adults: United States, 2005–2008. Department of Health & Human Services Centers for Disease Control and Prevention National Center for Health Statistics retrieved from http://www.cdc.gov/nchs/data/databriefs/db50.pdf
More References • Pender, N. J., Murdaugh, C. L., & Parsons, M. (2011). Health promotion in nursing practice (6th ed., pp. 44-50). Upper Saddle River, NJ: Pearson Education, Inc • Supplemental Nutrition Assistance Program Eligible Food Items. Retrieved November 18, 2013 from http://www.fns.usda.gov/snap/eligible-food-items • Thoms, S Childhood Obesity: Fitkids 360 aims to reverse the tide in Kent County. Retrieved from www.mlive.com/living/grand-rapids/index.ssf/2012/12/childhood_obesity_fitkids_360.html
More References • Thoms, S Childhood Obesity: Fitkids 360 aims to reverse the tide in Kent County. Retrieved from www.mlive.com/living/grand-rapids/index.ssf/2012/12/childhood_obesity_fitkids_360.html • Vartanian, L. R., Scwartz, M. B., & Brownell, K. D. (2007, April). Effects of soft drink consumption on nutrition and health: A systematic review and meta-analysis. American Journal of Public Health, 97(4), 75-667. doi:10.2105/ajph.2005.083782 • Vancouver Island Health Authority (2008) Rethink your drink. http://www.viha.ca/NR/rdonlyres/5B58772C-DA56-4D91-B53D-AA477D27CF37/0/ReThinkYourDrinkBlacklineMasterJUNE2008PDF.pdf • World Health Organization (WHO). 2013. 10 facts on obesity. Retrieved from http://www.who.int/features/factfiles/obesity/en